Rural hospitals serve populations that are disproportionately reliant on Medicaid

Last week, Gov. Sam Brownback declared that Nov. 16 is National Rural Health Day in Kansas. The day is an annual event hosted by the National Organization of State Offices of Rural Health to highlight the “selfless, community-minded, ‘can do’ spirit that prevails in rural America.” However, Rural Health Day also directs our attention toward the struggles and disparities that rural citizens and health care providers face every day.

The Brownback administration’s statement mentions 39 clinics that received $7 million in state funds for “community-based services,” a mobile health care service in Cheyenne County and the Neighbor to Neighbor day center in Concordia (where women can “learn skills such as chair yoga or pain management”). These are all innovative programs that help rural communities cope with their lack of health care resources, but it’s important to remember that rural health systems are suffering in Kansas. The state’s media release contained a single vague reference to the “challenges surrounding health care in rural communities across the state.”

According to a study by published by iVantage Health Analytics last year, more than 60 rural communities “experienced a hospital closure” between 2010 and 2016. Another 673 hospitals were “vulnerable or at risk for closure” when the study was released. If all of these hospitals were to close, iVantage estimates that “11.7 million patient encounters would be at risk,” while the U.S. economy would face “a potential loss of 99,000 healthcare jobs, 137,000 community jobs and $277 billion to the GDP.”

The study also found that one-third of the rural hospitals in Kansas are at risk of closure.

The Kaiser Family Foundation recently conducted a study of three hospital closures in the U.S. – one of which was the Mercy Hospital in Independence, KS. Local stakeholders in each community cited “high poverty and uninsured rates in rural communities, high rates of Medicare and Medicaid coverage, and declining populations” as reasons why their hospitals were under strain. The study also mentioned something the Brownback administration isn’t particularly keen to discuss: Rural hospitals disproportionately serve elderly, low-income patients – a population that’s heavily dependent on Medicare and Medicaid.

This is why it shouldn’t be surprising that, as KFF reports, “Changes in Medicare and Medicaid payment over the past few years have had an adverse effect on rural hospitals.” According to a recent study by University of North Carolina researchers (published in Health Affairs), rural hospitals in Medicaid expansion states are more profitable than they are in states that didn’t expand the program under the Affordable Care Act. This is why a huge number of health care providers across the state support Medicaid expansion – and not just the ones that serve rural populations. When SCL Health put St. Francis up for sale, it cited the state’s refusal to expand Medicaid as one of its reasons for doing so.

Even if you regard this as a dubious claim, many other hospitals make the same argument. For example, when Mercy Hospital System closed its facility in Independence, spokeswoman Joanne Smith said the failure to expand Medicaid cost the hospital $1.6 million per year.

Opponents of Medicaid expansion like Brownback and Lt. Gov. Jeff Colyer can “applaud and appreciate the great work of our rural health care providers and their staff” all they want, but it’s time to do much more than that. It’s time to expand Medicaid in Kansas.

Members of The Capital-Journal’s editorial advisory board are Zach Ahrens, Matt Johnson, Ray Beers Jr., Laura Burton, Garry Cushinberry, Mike Hall, Jessica Lucas, Veronica Padilla and John Stauffer.

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Editorial: Medicaid expansion would help rural hospitals